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Management of the Contaminated Operation

  • Jameson L. Chassin

Abstract

The incidence of postoperative wound sepsis varies with the magnitude of contamination. The generally accepted classification of operative wounds according to contamination, as listed by Altemeier et al., is:
  1. 1) Clean
    • Nontraumatic

    • No inflammation encountered

    • No break in technique

    • Respiratory, alimentary, genitourinary tracts not entered

     
  2. 2) Clean-Contaminated
    • Gastrointestinal or respiratory tracts entered without significant spillage

    • Appendectomy—not perforated—no cloudy peritoneal exudate

    • Prepared oropharynx entered

    • Genitourity or biliary tract entered in absence of infected urine or bile

    • Minor break in technique

     
  3. 3) Contaminated
    • Major break in technique, or gross spillage from gastrointestinal tract

    • Traumatic wound, fresh

    • Entrance of genitourinary or biliary tracts in presence of infected urine or bile

     
  4. 4) Dirty and Infected
    • Acute bacterial inflammation encountered, without pus

    • Transection of “clean” tissue for the purpose of surgical access to a collection of pus

    • Perforated viscus encountered

    • Dirty traumic wound

     

Keywords

Wound Infection Necrotizing Fasciitis Operative Wound Suction Catheter Presacral Space 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Alexander J W et al. (1976) Prevention of wound infections: a case for closed suction drainage to remove wound fluids deficient in opsonic properties. Am J Surg 132: 59PubMedCrossRefGoogle Scholar
  2. Amer Coll of Surg Subcommittee, Altemeier WA et al. (1976) Manual on control of infection in surgical patients. Lippincott, PhiladelphiaGoogle Scholar
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  9. Sindelar WF, Mason GR (1979) Irrigation of subcutaneous tissue with povidonedine solution for prevention of surgical wound infections. Surg Gynecol Obstet 148: 227PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York Inc. 1980

Authors and Affiliations

  • Jameson L. Chassin
    • 1
    • 2
    • 3
    • 4
    • 5
  1. 1.School of MedicineNew York UniversityUSA
  2. 2.University Hospital, New York University Medical CenterUSA
  3. 3.New York Veterans Administration HospitalUSA
  4. 4.Bellevue HospitalUSA
  5. 5.Long Island Jewish-Hillside Medical CenterUSA

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